DESCRIPTION (Applicant's abstract): In July, 1997, the State of Maryland is implementing managed care for its Medicaid enrollees, including all disabled persons (SSI) who are not on Medicare. General health care services will be provided by capitated managed care, but specialty mental health services will be provided through an administrative services organization (ASO) paying fee-for-service. The ASO will function like many managed indemnity insurance plans using utilization review and prior approval of treatment plans to control utilization and costs. The objective of this study is to assess the impact of these changes, primarily from the perspective of the consumer. The specific aims of the project are: (1) to determine the extent to which patterns of treatment change with the implementation of new managed care arrangements; (2) to assess the effects of these changes on outcomes including changes in treatment, usual provider, living arrangements, and informal care; and (3) to examine consumer satisfaction with access, service, providers, and the quality of care received under managed care and indentify factors associated with variations in satisfaction. A representative sample of severely mentally ill persons on Medicaid who were interviewed in 1995 (n=681) will be re-interviewed in 1998 and 1999. About 85% of these individuals are Medicaid eligible because they have met disability eligibility for SSI or SSDI. About one-third are Medicare enrollees, will not be subject to managed care, and will provide a comparison group to evaluate the impact of managed care. This project will be undertaken in collaboration with the Maryland Department of Health and Mental Hygiene.